following is an exclusive excerpt
from the "Birth Control" chapter of
Bodies, Ourselves for the New Century.
For complete information and resources,
we recommend that you consult the
chapter and the book in its entirety.
OBSTACLES TO GETTING
BIRTH CONTROL AND USING IT WELL
Control and Sex Information
Negative attitudes toward pleasure
and desire, and shame about sex, prevent
many of us from seeking information.
On a wider scale, these same attitudes
serve to keep sex information from
being distributed freely in schools
and community organizations. Laws,
medical practices, and public school
policies still prevent us from getting
the information and services we need,
especially when we are young--in spite
of many recent studies showing clearly
that giving birth control information
to teenagers does not make them more
likely to have sex.
In the 1960s and 1970s, some legislatures
and school boards reversed restrictive
laws, and parents, teachers, and community
people started good sex education
programs in several U.S. school systems.
More recently, groups such as the
Moral Majority and Christian Coalition,
supported by the policies of conservative
federal and state governments, have
attempted to reinstate the old restrictive
laws or pass new ones and to stop
existing sex education programs.
Who Protects Our Interests?
Women usually assume that when a birth
control method is available through
a doctor's office, medical clinic,
or drugstore, its safety and efficacy
have been proved. In the U.S., the
Food and Drug Administration (FDA)
regulates contraceptive devices and
substances, deciding which ones are
still experimental and which are legal
to prescribe and sell. All
birth control methods must be tested
first on animals and then on women
before the FDA approves them for marketing.
Often, drug companies test new methods
on women in Third World countries,
or on low-income women and women of
color in the U.S. When the effectiveness
and safety of the method satisfy federal
requirements, the FDA approves it
for general distribution and marketing.
However, the recent history of women's
contraceptives has shown that long-term
complications and negative effects
are rarely thoroughly understood when
methods are approved. FDA requirements
take up to ten years of work before
a drug is marketed, but it takes 20
years or more for some complications
to become apparent.
When we seek trustworthy advice about
birth control in order to make careful
choices, we find conflicting information
and false reassurances. Some of us
are prevented from gaining access
to birth control; others are obliged
to choose birth control without enough
useful information. According to a
WHO survey, different international
agencies publish guidelines with inconsistent
recommendations, and from one country
to another, information given to physicians
about a method's safety and effectiveness
may be contradictory. As a result,
"women seeking contraceptive services
in many countries may be subjected
to unnecessary tests, asked to return
for follow-up more frequently than
is appropriate, or told it is not
safe for them to use a method when
it would be safe.'' Much of the available
information about contraceptives comes
from the drug companies that make
them, and is biased accordingly. Health
care providers may be influenced by
drug company literature and sales
personnel. Furthermore, physicians
often recommend their own favorite
method, which may not be the best
one for us. And it is alarming that
many physicians tend to recommend
whatever methods they have available
at the time of our visit.
A number of other factors can undermine
our choices, including substandard
health services and, in some countries,
the need to obtain a husband's consent
before we can get birth control. Thus,
many of us find ourselves using inadequate
or downright dangerous methods. Some
of us, unwilling to go through the
hassle, end up using nothing at all.
A method that sits in a drawer or
that isn't used properly won't be
effective no matter how technically
sophisticated it is.
and Birth Control
Most women and men assume that the
responsibility for birth control should
fall on women. One reason is that
women have more at stake in preventing
pregnancy than men do, for we bear
the children and, in most cultures,
are primarily responsible for raising
total responsibility for birth
control on women is inappropriate
and unfair. It usually means that
we must make arrangements to see a
practitioner for an exam and a prescription,
go to the drugstore, pay for supplies,
and make sure they don't run out.
With the Pill or IUD, we feel the
effects and, more seriously, take
whatever risks are involved. If we
don't have some kind of birth control
and a man presses us to have intercourse,
we need to say no and make him accept
our refusal. If we become pregnant,
it is said to be our fault. Total
responsibility often creates anger
and resentment that can't help getting
in the way of our sexual pleasure.
Many of us do not talk much about
birth control with our partners. We
may have sex with someone we've just
met or don't know very well and find
it difficult to bring up the subject,
or we may be in a relationship in
which communication is generally a
problem. Yet, a man can share the
responsibility of birth control in
several ways. When no good method
is available at the moment, a supportive
partner will join us in exploring
ways of lovemaking without intercourse.
He can use condoms and not just when
we remind him to, help pay the doctor
and drugstore bills, remind us to
take the Pill each day, help to put
in the diaphragm or insert the foam,
check to see if supplies are running
low. He can have a vasectomy, if we
have a long-term relationship in which
no children, or no more, are wanted.
A man who truly shares responsibility
for preventing pregnancy may gain
our respect. We feel better about
our relationship and use birth control
better, as well.
Women and Birth Control
The increased availability and effectiveness
of birth control methods can encourage
friends, husbands, lovers to pressure
us to have intercourse whenever they
want to. We need to be assertive about
our desires. Being protected
from pregnancy does not always mean
we want intercourse.
Many of us have found that we ourselves
resist using birth control. Sometimes
this is because of social and political
factors such as poor sex education,
a double standard concerning sex,
or inequalities between women and
men. For instance:
are embarrassed by, ashamed of,
or confused about our own sexuality.
cannot admit we might have or are
having intercourse, because we feel
(or someone told us) it is wrong.
are unrealistically romantic about
sex: Sex has to be passionate and
spontaneous, and birth control seems
too premeditated, clinical, and
hesitate to ``inconvenience'' our
partner. This fear of displeasing
him is a measure of the inequality
and our lack of control in our relationship.
feel, ``It can't happen to me. I
won't get pregnant.''
hesitate to find a health care practitioner,
who may turn out to be hurried,
impersonal, or even hostile. If
we are young or unmarried, we may
fear moralizing and disapproval.
We may be afraid the practitioner
will tell our parents.
don't recognize our deep dissatisfaction
with the method we are using, but
we begin to use it haphazardly.
feel tempted to become pregnant
just to prove to ourselves that
we are fertile or to try to improve
a shaky relationship, or we want
a baby so that we will have someone
to care for.
Can We Do?
Each of us will have different opportunities
for action, depending on where we
live, how old we are, what resources
are available to us, and how much
political power we have. But all of
us can learn for ourselves and teach
one another about the available methods.
By speaking openly and by carefully
comparing experiences and knowledge,
we can guide one another to workable
methods and good practitioners. We
can recognize when a practitioner
is not thorough enough in examinations
or explanations and encourage one
another to ask for the attention we
need. By talking together we can also
get a better handle on our more subtle
resistances to using birth control.
We can begin the long but worthwhile
process of talking with our male partners
about birth control, encouraging them
to share the responsibility with us.
We can join together across state
and national boundaries to insist
that legislatures, courts, high schools,
churches, parents, doctors, research
projects, clinics, and drug companies
change their practices and attitudes
so that we can enjoy our sexuality
without becoming pregnant. We can
create self-help clinics and other
alternative health care institutions
where our needs for information, discussion,
and personal support in the difficult
choice of birth control will be better
met. We can use the good clinics that
do exist. We can campaign for decent
housing, jobs, and child care for
all, so that we can choose birth control
freely instead of being forced to
use it by our circumstances. We can
insist that birth control methods
meet the needs of all women, including
women of color, women living in poverty,
women with disabilities, and women
in developing countries. Whatever
we choose to do, we can act together.
© 1984, 1992, 1998 by the Boston Women's
Health Book Collective. All rights
reserved. Published by Touchstone,
a division of Simon
& Schuster Inc.
order Our Bodies, Ourselves for
the New Century