The Social Construction Of Hormonal Contraception

Abstract

This paper explores the socio-psychological consequences of the increased distribution of hormonal contraception among young women in the United Kingdom as a policy response to high rates of teenage pregnancy. Focus in placed on women aged 18–24 as this group exhibits the highest consumption of hormonal contraception in the country. The study employs focus groups to consider the impact of hormonal contraceptive use on the knowledge, choices, responsibilities, and sexual identities of British women. The findings demonstrate that although birth control methods have created positive sexual and social freedoms, users nonetheless experience an “expectation” to use hormonal contraception as part of their sexual identity. Furthermore, participants described a myriad of negative side effects with the use of birth control methods that negatively impacted on their social identity. The research concludes that explorations of how hormonal contraception impacts on the social and sexual identity of British women remains understudied and that further research is essential to encouraging effective policy-making goals and improving the general well-being of the female population.

Keywords

Sexual identity; hormonal contraception; young women; British healthcare.

Introduction

This paper explores how the increased distribution and consumption of hormonal contraception (HC) since the 1960s has transformed the social and sexual identity of British women aged 18–24. Focus is placed on this demographic as it represents the highest consumption of HC amongst all age groups in the country (Krishnamoorthy et al., 2008). The study considers whether the increased distribution of HC has been introduced for political and economic ends without fully assessing the long-term socio-psychological disadvantages to British women. It explores the role of the government, popular culture, and a difficult history of modern contraceptives to establish how these sources have influenced women’s knowledge, choices, and responsibilities in the spheres of sexuality and sexual health.

Two key issues have encouraged the increased distribution of HC. On a global level, overpopulation has been recognized as a socio-economic issue for the last century (Glasier et al., 2006). On a national level, the British government has sought to address high rates of teenage pregnancy — statistically the highest in Europe (Krishnamoorthy et al., 2008: 98). Medical research suggests that HCs are potentially harmful to users, causing both minor and major health risks. Side effects include: decreased sex drive; weight-gain; mood changes; skin problems; depression; initiation of adverse neurological conditions and the increased risk of serious illnesses such as thrombosis (McClelland et al, 2002; O’Connell, 2007; Burke, 2011; Sitruk-Ware et al, 2012; Jain, 2013; Nielsen et al, 2013; Xu et al, 2014). Despite these known side effects, statistics show a dramatic rise in the consumption of HC, particularly among young women (Glasier et al., 2006; Jain, 2012). In Britain, 65% of women aged 16–19 and 84% of women aged 20–24 use HC (Glasier et al., 2006: 1595). This is the largest consumption of HC amongst all age groups. It is therefore pertinent to explore what (and who) influences young women in their decision to use HC despite its potential risks to their health.

The consumption of HC has increased dramatically since the 1960s, but there is an academic gap exploring how this development has shaped the social and sexual identity of British women. Thus, it is not known whether there is a connection between an increased use of HC and the changing social and sexual identities of British women. As HC is consumed by a large number of British women, it is essential to understand how the widespread consumption of HCs may have influenced ideological, moral, and social shifts.

A Brief History of Contraception

Contraceptive methods have been employed for thousands of years, with the earliest recorded use dating back to Ancient Egypt (period-period) (Cook, 2004). Historically, among women chemical contraceptives were prevalent, with ‘fruit acids, jellies, pastes and various mixtures [inserted] into their vagina to prevent conception’ (FPA, 2010). Male barrier methods have included moistened linen sheaths, condoms made from animal intestines, and rubber condoms (ibid). This variety of unusual (and often ineffective) contraceptive methods is indicative of the historic difficulties in practicing safe sex and preventing conception.

For lack of a better medical solution, population control was encouraged through abstinence and education (Cook, 2004: 155). The absence of appropriate scientific solutions had, instead, inspired social solutions. Britain in the nineteenth and early twentieth century relied on family, church, and schools ‘to supervise and control unmarried women’s sexual behavior’ (ibid: 3). Women were taught to see sexual responsibility as a moral duty to society. In Victorian Britain, sexual education encouraged a ‘duty to avert conception’ amongst women (Rappoport, 2014: 149). Family planning education was diffused amongst various social institutions and non-governmental actors, and moral and sexual responsibility was affiliated with women — no such social expectations were encouraged among men. This long history of feminine expectation sets the political landscape for a nation accustomed to treating fertile women of reproductive age as “dangerous” citizens. This ideology would later serve as a social mandate for the maltreatment of women’s bodies as sites for political debate.
Until the early Twentieth Century, most contraceptives were unregulated by government institutions or medical practitioners. The British Government and British Medical Association were originally reluctant to support mass distribution of contraception, and much of the ‘onus for informing and educating the general public in the practicalities of contraception ha[d] fallen to a large extent on the commercial sector’ (Wood and Suiters, 1970: 160). The onus inherited by pharmaceutical companies was to set an important economic precedentwhich would impact the distribution of hormonal contraception in post-industrial societies in the Twentieth Century.

The opening of the first Family Planning Clinic in London (1921) signaled the beginning of popularized access to contraception (Cook, 2004: 4). The build-up to this historic event introduced sophisticated birth control methods, including Intrauterine Devices, Chemical Contraception, and improved Female Barriers. But this period was not without its issues. The decade was marked by ‘limited knowledge as to why birth control methods were effective’ (ibid: 124) and a lack of support amongst doctors. The moral climate in Britain resulted in conservative approaches to the distribution of contraception, and government-regulated methods were only available to married women ‘on medical grounds’ (ibid: 272). These methods were ‘generally crude, unreliable, expensive and difficult to obtain’ (Campbell, 1960: 143). However, the thousands of years of ineffective birth control methods and conservative (if not sexist) approaches to sexual health were to be challenged by the emergence of the “medical miracle” of the 1960s: the oral contraceptive pill.

The Era of “Not-For-Conception” Sex

The oral contraceptive (OC) pill was first introduced in 1961, and commended ‘as the modern way for a woman to manage her fertility’ (Bennet and Pope, 2009: xi) by offering the user a sense of freedom and empowerment. These positive associations meant that the ‘use of the pill steadily increased throughout the 1960s’ (Cook, 2004: 2). A new wave of feminist thought believed that conception would be removed from the “sexual equation” and thus encourage a climate of sex for sexual pleasure, ‘individual satisfaction and self-expression’: for men and women (Solinger, 2013: 23; Cook, 2004: 295). Conservative ideologies were to be trumped as contraceptives were understood to ‘play an essential part in population regulation’ (Jain, 2013: 320). This understanding was to grant the government access to influencing the distribution of HC.

In the late 1960s, social concerns re-emerged. Many feared that the pill was a dangerous and capricious drug exploiting young single women (Cook, 2004: 3). A long history of women’s economic responsibilities in the home had contributed towards a moral panic that HC was encouraging sexual promiscuity. Cook explains that this view — which still resurfaces in modern-day discussions — assumes that ‘women never possessed the right to say no — or yes — to sex on the basis of their desire’ (ibid: 2). The rise of a sexual revolution and, thus, a change in attitudes towards sex was to generate new political, economic and sexual issues in the United Kingdom.

Today, the United Kingdom has the highest rates of teenage pregnancy in Western Europe (Krishnamoorthy et al., 2008: 98). Since the 1980’s, government policy has aimed to confront the issue. The UK National Teenage Pregnancy Strategy in Western Europe (Krishnamoorthy et al., 2008: 98). Since the 1980’s, government policy has aimed to confront the issue. The UK National Teenage Pregnancy Strategy (1999) highlighted the necessity of highly subsided sexual health programs offering contraceptives free of charge. Access to Emergency Hormonal Contraception (EHC) was heavily marketed in an effort to reduce levels of (unwanted) teenage pregnancy. Krishnamoorthy et al.’s (2008) quantitative study assessing changes in the number of British adolescent females prescribed HC found that in the periods 2000–2001 and 2005–2006, the proportion of women aged under sixteen and between the ages 16–19 consuming HC had increased by 82% and 53%, respectively. The number of individuals aged 10–16 obtaining HC from a primary care physician had increased fivefold (Krishnamoorthy, 2005). These statistics suggest that government policies have succeeded in increasing HC distribution, but has this ameliorated issues of overpopulation and unwanted pregnancy?

The subject of teenage pregnancy rates remains controversial amongst researchers. Government-issued policy documents insist that the increased distribution of HC since 1999 has decreased levels of teenage pregnancy in Britain (Teenage Pregnancy Strategy, 2010). However, critics argue that this reported fall in fertility rates — considered a political and economic success — has, ironically, ‘led to reduced funding for contraceptive research and most importantly, investment in family planning services’ (Glasier et al., 2006: 1601). These circumstances can potentially reduce women’s access to knowledge and advice on HC. Similar research has reported that increased distribution has not impacted levels of unwanted pregnancy. Sitruk-Ware et al. (2012) identified that ‘developed [societies continue to] suffer from unacceptably high rates of unintended and unwanted pregnancy, despite the availability of safe and effective forms of contraception’ (p. 319). The United Kingdom has the highest rates of teenage abortion in Western Europe, with almost half of all teenage conceptions considered ‘unwanted pregnancies’ leading to abortion (Family Planning Association, 2010).

Black et. al (2006) researched the factors associated with the use of EHC amongst British women, and found that its use ‘was more common among younger, single women’ (p. 309). Use of EHC was highest amongst women aged 16–19 years (6.9%) and 20–24 years (4.2%) (ibid). However, the report argues that ‘enhanced access to EHC has not been found to impact on rates of unplanned pregnancy’ (ibid). It appears that despite the ‘widely disseminated [government] policies’, levels of teenage pregnancy ‘have remained largely unchanged or have even marginally increased’ (Krishnamoorthy et al, 2008: 101) whilst levels of HC consumption amongst young women continues to increase. It is therefore worth asking: if HC has not impacted rates of unplanned pregnancy, then what has it impacted?

Feminist academics in opposition to HC have argued that its high consumption amongst women is  potentially excessive and dangerous (Pope and Bennet, 2009; Grigg-Spall, 2013). Ironically, ‘any criticism [of HC] is considered irresponsible’ or anti-feminist (Grigg-Spall, 2013: 14). In fact, argues Grill-Spall, the exorbitant distribution of birth control is anti-feminist. The OC pill is ‘the sacred cow of the medical industry’ and falsely ‘protected defensively by those advocating for women’ (p. 14). For example, the OC pill Yasmin(Yaz), was pharmaceutical company Bayer’s second-best selling drug, amounting to $1.5 billion in sales in 2010 (ibid: 8). The massive global profitability of HCs mean that pharmaceutical companies have often been reluctant to disclose the negative implications of HC’s mass consumption on female users. The OC pill was founded on a ‘gender bias within the medical industry’ (ibid: 8, 9), and was not created with women’s issues in mind. Instead, birth control methods are essentially more beneficial to its producers than its end users (Li, 2014). In response to these issues, there exists a divide between ‘those who believe reproductive rights are a private matter, and those who believe they are a public matter to be legislated by government bodies’ (Solinger, 2012: 2).

2.3    Health and Well-Being

There are many contraceptive and non-contraceptive benefits of HC. Obvious examples include allowing women to control their fertility and effective protection from unwanted pregnancies. Burke (2011) explains that the ‘benefits of … contraceptives include effectiveness, safety, and improvements in menstrual symptoms … Non-contraceptive health benefits … include improvement in such symptoms as dysmenorrhea, menorrhagia, premenstrual syndrome, and anaemia’ (p. 15). Grigg-Spall (2013) describes the popular marketing of the OC pill as a “wonder drug” for women. OC pills like Yasminwere popularised as ‘a diet drug, a beauty product and a contraceptive all rolled into one’ (p. 40).

However, feminist research has argued that these drugs have often been ‘promoted for unapproved uses’ (ibid: 42) and without fully explaining the dangerous side effects. For instance, thrombosis is regularly cited as a serious risk to OC pill users; five research studies show that HCs hold a fifty to seventy-five percent increased risk of causing blood clots amongst users (Landau et al., 2006 : 11). It is thus essential to understand whether users of HC are aware of these health risks, and if so, what encourages them to continue its use.

2.4    Choice, Knowledge and Responsibility

Johnson, Pion and Jennings (2013) researched women’s awareness of contraceptive methods, their reasoning behind choosing and changing methods, where they seek advice on contraceptive information, and whom they consult during their decision-making process. Their work surveyed women aged 25–44 in the USA, UK, Germany, Italy and Spain using a questionnaire-based study. Their findings demonstrate that knowledge of the male condom and contraceptive pill predominated data, although participants across all countries showed good awareness of many other contraceptive methods. Doctors were regarded by participants as the most influential source in their decision-making process, and commonly prescribed the OC pill or condoms. Although the data surveys older women and across several western countries, the work nonetheless signals the predominant use of the OC pill amongst women, and the condom amongst men.

The gender-specific distribution of contraception can be linked to discussions on gendered sexual responsibility. Findings explain that the ‘pill for women, and the condom for men account for almost 50% of overall contraceptive use’ (ibid: 7).  Assigning contraceptives to individuals on a gender-basis has proven problematic for women. Pope and Bennet (2009) explain that as a result, ‘women have a greater contraceptive motivation and willingnessto do harm to themselves in order to prevent an unwanted pregnancy’ (p. 282, italics in original). This reasoning is rooted in historic understandings of fertile women as “dangerous”, particularly when “promiscuous”. Furthermore, the nature of sexual health advertising has encouraged a culture of the ‘medicalisation of women’s bodies’ (Vardemann-Winter, 2011: 283). Feminist academics argue that the support for women using HC is built into the patriarchic structure of societies which favour the political, economic and sexual interests of men (Nya-Ngatchou and Amory, 2013; Liu et al., 2010; Tong, 2007). In turn, there appear to be ‘large-scale ideological, economical and social forces at work’ to ensure sexual responsibility is maintained amongst women (Grigg-Spall, 2013: 17). The condom, on the other hand, has no known serious health-related side effects, and thus no health impact on the male users (Merkh et al., 2009). In light of the gendered distribution of contraception, and the various dangerous side-effects of HC, Burke (2011) insists that ‘there is a need to expand the currently available contraceptive choices … [and] [t]he development of better tolerated methods’ (p. 176).

Yet, HC is marketed as presenting women with the “choice” to control their fertility. Solinger (2013) argues that “choice” in discussions of sexual politics is a deliberate apolitical use of language. Thus, ‘the language of choice gradually permeated women’s decision-making in other domains and paved the way for a culture of “choice feminism”’ (p. 48). Coined by Hirschman (2007), ‘“choice feminism” indexes the shift to personal (rather than social and political) choices made by women in domains such as paid work, domesticity and parenting, sexuality, as well as grooming’ (Cohen, 2006: 43). HC has most certainly created a way for women to assert greater control over their sexual health and well-being. The ability to “choose” how one effectively practises safe sex is a revolutionary turn in the history of women’s progression. Nonetheless, sexist undertones in the distribution of HC are arguably problematic. HC campaigns and advertisements have often utilised the language of “choice” to present women with options to take drugs which may uphold the expectation that sexual responsibility is a woman’s duty to society

2.5    The Commodification of Feminine Sexual Identity

Zurbriggen et al. (2007) assert that ‘the sexualisation of girls has negative consequences in terms of girls’ ability to develop healthy sexuality’ (p. 3). The ‘frequent exposure to media images that sexualise girls and women affects how girls conceptualise femininity and sexuality … Young women who more frequently consume or engage with mainstream media content offer stronger endorsement of sexual stereotypes that depict women as sexual objects’ (ibid). The hyper-glamourised and sexualised icons of women in the media have become common in the twentieth and twenty-first century (Leonard, 2007: 104; McRobbie, 2000: 67; Gavey, 2005). If these claims are correct, then generations of young women who are aligned with these sexist hyper-sexualisations of women — young women who are statistically most likely to consume HC — are at risk of engaging in sexual activity with distorted understandings of their roles, freedoms and choices (Ward, 2002; Ward & Rivadeneyra, 1999; Zurbriggen & Morgan, 2006).

McCracken (2014) suggests that the twenty-first century is marked by its ‘relentless domination and imperialism over women’s bodies’ (p. 2). The persistent politicization of the female body is reminiscent of the view that women are unable to assert full command over their appearance, choices, and health (Cook, 2004). This overarching power is witnessed in various spheres, particularly in sexuality and beauty. Although HC has granted women access to new sexual freedoms, their autonomy operates within patriarchic frameworks that continue to control how their sexuality is expressed. What McCracken defines as, The Global Political Economy of Beauty, she accuses of merging the areas of ‘production, marketing, distribution and consumption’ with ‘the construction of gendered bodies, youth cultures, social identifications, the blurring of distinction between public and private spheres’ (ibid). This beauty industry has been shaped to benefit a social hierarchy imposing sexual politics on the bodies of Western women. For instance, Grigg-Spall (2013) describes her reliance on the OC pill as synonymous with her various other feminine responsibilities ‘as a woman … like shaving [her] legs or wearing make-up’ (p. 21). Much like the consumption of beauty goods, HC represents a similar expression of feminine freedom — the use of birth control is rendered a method of “controlling” one’s fertility, in a similar vein to controlling one’s appearance (Grigg-Spall, 2013: 23).

Such economic conditions have led to the rise of ‘a new feminine subject’, defined as the ‘sexual entrepreneur’ (Gill and Schraff, 2011: 52). This identity paradigm manifests itself as a ‘modernization’ of femininity, emerging over the last two decades in the wake of the ‘sexual revolution’ and ‘the acceleration and intensification of neoliberalism and consumerism’. This ‘“new femininity” constitutes a hybrid of discourses of sexual freedom for women, intimately entangled with attempts to recuperate this to (male-dominated) consumer capitalism … wrapped in a new glossy post-feminist guise’ (ibid). This condition is described as

… a contradictory feminism and sexual liberation with the neoliberal incitement to constant self-improvement through hyper-consumption. The representation of  such sexual self-improvement as a matter of ‘choice’ and ‘empowerment’ obscures the narrow, tightly policed boundaries that remain around feminine intelligibility (ibid).

It is within this neoliberal and post-feminist climate that we must examine the impact of HC on British women. Knowledge, choice, and responsibility are important variables in determining why women use HC methods (Zurbriggen & Morgan, 2006; Ward, 2002; Ward & Rivadeneyra, 1999).

Findings

Focus group one (F1) consisted of five women aged 19–21 who live together in shared accommodation. The group were intimately connected and shared a strong social bond. F1 appeared comfortable discussing personal issues and noted prior to the recording that they often discussed sexual health. Focus group two (F2) consisted of five women aged 18–20 who were from a mutual friendship group. The group had been friends for several months but appeared intimate. The group stated that they did not discuss sexual health often. Focus group three (F3) consisted of five women aged 20–24 who were in a close friendship group. A few members of F3 mentioned discussing sexual health with one another. Group members spoke freely amongst themselves without much prompting. In all groups, participants talked openly about their sexual health. Fourteen of the participants use HC, and one (F1, aged 20) stated that she no longer used any form of contraception with her boyfriend. The participants openly asked one another questions which allowed me as researcher to observe the flow of the conversation. All participants were British.

4.1    Knowledge

The participants’ knowledge on HC was sourced from various outlets. Participants mentioned sexual education in school, friends, magazines, information from doctors, and parents as sources. Friends and doctors were commonly mentioned as the most influential sources of information. Secondary schools were cited as providing “scientific” renditions of sexual health, but were criticized for not offering enough information on the emotional elements of sexuality. F1 discussed their early experiences of sexual education, and how their secondary schools influenced their knowledge of HC:

J: I remember when we were in year 9, and we were given the C cards, even though we were completely single (group laughs) and there was no sex in the pipeline and [we] went to all the clinics and got all these condoms…

E:I think it’s a good thing that you can do that, and know where to go and where to get them, even if you’re not going to use them. It’s a good way of educating people.

O:But the question isn’t “why do you want to have sex?” it just tells you how to have sex.

J’s anecdotes prompt E and O to introduce their views on the sexual education system. Although J reflects on the experience of getting condoms from clinics as a mindless activity, E asserts that this access to contraception is a positive aspect of British sexual education. However, O’s comment interrogates the views of both J and E by delving into the deeper issue, “do teenagers understand what sex is?”. This leads to the following discussion:

Researcher:So do you think people are desensitized from sex is supposedto be, O?

K: I think sex education makes sex quite scientific and what to do when you will have sex. It’s very biological. And what to put on when you do it.

J: You’re taught it in science but the school can’t teach you how you’re going to feel…

K:You learn as you’re doing it… (Pause)

J:And you learn from your parents and peers…

O:I think my parents influenced me a lot. My mum was very open. I learnt more from her than from sex ed.

A: It’s one of those personal things that you just have to learn for yourself.

Although the researcher’s question was aimed at O, K and J responded, but with a different approach to the earlier excerpt. O’s comment on the “meaning” of sex prompted them to explore whether the delivery of sex education was appropriate to their experiences as young women. J introduces “feelings” into the discussion, which leads both K and J to trail off as they reconsider their opinions. O returns to the discussion, introducing her mother as the main source of her knowledge, and disregarding any knowledge acquired from sex education. A introduces the importance of “independence” in learning what sexuality means to the individual, describing sex as a “personal” learning experience. Her comment implies that individual understandings of sexuality, responsibility, knowledge and choice are a personal experience that cannot be explained simply through political and social education. Despite its importance in public health policy, sexuality is understood as a private domain for the individual.

4.2   Choice

Choice is an important issue in the consumption of HC, particularly as statistics demonstrate that most women use the OC pill. It is worth considering whether this statistic is reflective of the independent choices of women, or the result of doctors encouraginguse of a particular method. F2 discuss freedom and choice:

Researcher: Do you think hormonal contraception has provided users with freedom and choice?

H: Mostly yes. I do feel bad that we’re complaining when we’re lucky enough to have the NHS and free contraception. Not having free access to choose your pill can mean feeling a bit out of the loop.

R:I’d like to be more involved in the process of choosing the most appropriate pill for me.

H: It feels a bit like they’re automatically assigned without much consultation, besides the more general choice between the POP and regular pill.

C:It’s a bit like, ‘You’re having sex? Have the pill! Bye!’

(Group laughs)

 

H’s interesting use of words (“complaining” — a common sexist misconception that women often “complain” about things; “lucky” — a suggestion that women’s freedom to use HC is a matter of chance rather than autonomy) highlights the various sexist undertones that exist in British society. Although she refers to contraception as “free”, she argues that her choice of HC is not “free” and although she may not pay for her HC, she feels uninvolved in deciding which method best suits her needs. This comment prompts R and C to rethink their attitudes towards distribution of the pill, and the three women agree that the OC pill is commonly prescribed as a standard method of birth control. It is problematic that H expresses “feeling bad” for “complaining” instead of conceptualising her access to sexual healthcare resources as a “right”. They continue on the subject of autonomy:

T:Taking the pill is kind of like doing my make-up or going to university. It’s just a daily thing that’s become a habit.

Y:Well, I feel totally cut off from what my body is supposed to do. I have no idea when my period really is or what my body is doing. I feel a bit, like, artificial.

This comment inspires an interesting debate in F2, with the women beginning to critically examine their choices, suggesting that they may not have considered the topic in depth before. Y expresses anger that HC has left her “feeling” disconnected from her body. Her relationship between body and mind suggests that her choice to “control” her fertility means she cannot “control” her body’s natural menstrual processes. T compares her use of the OC pill to her daily health and social responsibilities. This echoes Grigg-Spall’s (2013) argument that HC has become a regular responsibility which is similar to other expressions of “femininity” such as wearing make-up or shaving. Whether this expression is a choice or a socially-imposed responsibility, however, is debatable.

4.3   Responsibility

Discussions of responsibility surround issues of feminine responsibility, sexual autonomy, and, often, “slut-shaming”. To be responsible is a rewarding consequence of autonomy. F1 discuss how HC has impacted their sexual and social responsibilities:

O:Do you think there’s more pressure for the girl to sleep with the guy? Why don’t you just take contraception and we can do “it”?

Researcher:Are we at a point now where HC has created additional responsibilities for women?

K:Yeah, precisely, we’re given all these freedoms but instead we’re expected to do more things than before and the obligations are intense. It’s like that question, how many people have you slept with?

A: Women have the responsibility to not be slutty and to take the pill.

O is posing a question to the group, suggesting that the use of HC encourages the idea that a woman is sexually available. The topic of responsibility prompts the participants to discuss freedom and sexual expectations. K is bridging the discussion of sexual health with “shame”, suggesting that to be irresponsible with contraception or to not use contraception is a marker of a lack of self-respect. This element is problematic as it suggests that unless a woman uses HC, she will be “shamed” for her choices. To not use HC suggests that she is reckless, stupid or irresponsible. This turns the discussion to qualifying what being “slutty” means. Aargues that women are expected to take the pill but also expected to not be “slutty”, a paradox in women’s responsibilities which serves as an overarching ideology influencing sexual behaviour and sexual responsibilities. F3 discuss sexual expectations and safe sex:

Researcher:And what about condoms? What does it mean when a woman carries one?

M: When a woman carries a condom it suggests she’s “expecting” to get laid… (Group laughs)

L: I carry one because I’m a huge slut! (Group laughs)

M: … Men are allowed to carry them because that’s considered their responsibly, and like, we are expected to take the pill.

Z:Sometimes carrying a condom feels like a very masculine thing to do.

The conversation explores what it means to be “slutty”. The group laugh at M and L’s comments, suggesting that they are amused by sexist connotations on condom-carrying. They mention that men are “allowed” to carry condoms whilst women are “expected” to take the pill. Z regards a woman carrying a condom as a “masculine” expression of sexual responsibility. This excerpt suggests that men’s sexual health is regarded as a “responsibility”, whilst women’s sexual health is an “expectation”. F3 are invited to discuss male contraceptive methods:

Researcher:How do you feel about a male contraceptive pill?

M:It’s like when my boyfriend and I went to New York. I was constantly carrying the fucking camera. I was like, ‘babe, can you carry the camera?’ and he’d be like, ‘oh no, you do it!’ I think men should start to be, like, more responsible for their bodies instead of always dumping what they don’t want to do on us.

L: Men are much more sexually irresponsible than women.

Researcher:Why do you think that?

L:They can have sex as much as they like, while we have to act like we’re not into it.

M’s anecdote presents an interesting example of how female responsibly exists in various aspects of  a relationship. The mention of a male contraceptive pill inspires an anecdote of M being asked to do something despite not wanting to. She associates HC with a responsibility “dumped” on women. Despite being granted “sexual responsibility” instead of “sexual expectation”, men are not regarded as using this liberty wisely. In response, L argues that men are in fact sexually irresponsible because they are simply allowed to be. A discussion on responsibility over one’s body and sexuality took place in F1:

O:I know taking contraception is supposed to be some sort of sexual responsibility but I experienced so many bad side effects that it didn’t feel responsible to take it any longer!

Researcher:What side effects?

O: Depression, bloating, mood swings… I totally lost my sex drive. What’s the point in taking the pill if you don’t want to have sex?! (Group laughs)

E: Yeah, those side effects can make you feel unsexy.

Researcher:Did feeling unsexy impact on your sexuality and sexual identity?

E: Yes, of course, I felt like I didn’t have one. I hated the pill.

When asked if any other participants had experienced negative side effects from the use of hormonal contraception, all participants in F1 said they had. F2 and F3 presented similar results, with the participants listing “depression”, “weight-gain”, and “acne” as negative side effects. O asserts that responsibility to her health had become more important to her than her “sexual responsibility”, arguing that the pill had caused her to lose interest in sex, and thus was not beneficial to her sex life.

4.4    Discussion

In the groups, men were commonly constructed as the “other”, whilst women were identified as a collective through the use of pronouns “we” and “us”. Participants constructed a collective voice that represented the views of young, sexually active women. Several participants identified as feminists, and presented challenging views within the groups. The other participants were responsive to these interrogations and in turn, openly re-considered their views on the subject. Within each focus group, certain participants dominated the conversation. For instance, in F1 the most dominant speaker was supportive of HC (E), whilst in F3 the most dominant speaker was against HC (M). Other participants showed nuanced opinions, and shifted their ideas as the conversation developed and subjects changed. Thus, the most dominant voices were expressed by the women who openly identified themselves as “feminist”. This suggests that knowledge of sexism and feminism can inspire increased knowledge and informed choices. The diverse voices within the groups included women who had religiously conservative upbringings and a woman not currently using HC. Furthermore, the ethnic diversity within the groups (six participants identified as non-white British) provided interesting collective understandings between women who had different cultural understandings of sexuality and responsibility. The normative discourses explored women as living with sexual responsibilities, and the expectations of women to use HC and men to carry condoms. Interestingly, whenever a speaker contributed a controversial (but sarcastic or ironic) comment which identified women as inferior, the other participants laughed. It is as though the women understood the pain embedded in the comment, and wished to support the speaker through humour and collective empathy.

 

5. Summary

The number of young British women consuming HC has increased rapidly in the last ten years (Krishnamoorthy et al., 2008). With a myriad of health problems associated with the consumption of birth control methods, it is essential to study how these circumstances have impacted the sexual identity of users. Although the increased consumption of HC may benefit family planning policies, the general well-being of British women is nonetheless paramount to their political, economic and social progression. The research findings indicate that participants using HC have allexperienced disruptive and/or problematic side effects. These have ranged from acne to serious depression. Despite these side effects, several women had continued consuming HC for a variety of reasons, ranging from various social expectation, sexual responsibility in heterosexual relationships, advice from doctors, and personal choice.

The results support the proposed hypothesis, suggesting that the increased distribution of HC has perpetuated feminine “sexual expectations” and “responsibilities” which can impede on their ability to make fully-informed and autonomoussexual health choices. Furthermore, the findings uphold the notion that women are more prepared to harm their health in order to prevent conception (Pope and Bennet, 2009). The data and literature suggest that medical practitioners appear to significantly influence a woman’s choice to take HC. Unfortunately, pharmaceutical companies mainly disregard the interests of women, and function on a profit-orientated basis (Grigg-Spall, 2013; Li, 2014). Considering the huge profitability of HC for pharmaceutical companies, there appears to be a conflict of interests between protecting the health and well-being of women from governmental actors, and the profit-orientated interests of drug companies. Feminist issues are rarely regarded in the distribution of HC. Finally, although the findings present interesting results, the research scope was small, and thus, there is a need for further feminist research on the views of larger numbers of British women.

5.1   Conclusions

HC has allowed users greater control of their fertility, and government policy initiatives have certainly increased awareness of sexual health. Participants in the focus groups argued that sex is an important part of self-expression and meaningful relationships. This is a progressive advancement from the more conservative approaches of the pre-1960’s period when sex was understood as a means for conception within marriage. However, participants explained that they felt their sexual activity could be regarded as controversial or “unacceptable”, implying that women’s sexuality remains monitored and politicised by various social and government actors. The results indicate that there exists a culture of “sexual expectation” and “responsibility” to use HC amongst young British women. Most participants demonstrated readiness to use contraception, but few showed broad awareness of how HC impacted their health and sexual identity, beyond recounts of personal experience. These results may be the product of a media-induced culture of fear which associates unplanned pregnancy with poverty and irresponsibility, and thus encourages women to use HC without fully understanding its negative implications. Beyond this, as all participants had experienced one or more negative side effects, it is essential for the British government to continue improving current methods of HC, and introducing non-hormonal alternatives. Finally, HC must be distributed in a manner that promotes equality between genders, improved health and sexual freedoms amongst users, and an increased access to important information on sexual health.

5.2   Suggestions

While there is significant research exploring the health and political implications of the increased distribution of HC, future research must explore how HC has impacted (and continues to impact)  on the sexual and social identity of British women. It is also essential for Research and Development  (R&D) to continue improving current birth control methods. I offer the following recommendations:

1. Encouraging funding for the R&D of non-hormonal contraceptives. For instance, an improvement of the female condom or natural family planning methods would benefit users of HC who experience health problems or find HC methods unsuitable;
2. Expanding research on how women are negatively impacted by the consumption of HC;
3. Restructuring government programs on teenage pregnancy prevention to regard the short-term/long-term interests and health of British women.