SOME OBSTACLES TO GETTING
BIRTH CONTROL AND USING IT WELL

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.

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.

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 them.

Placing 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.

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:

• We are embarrassed by, ashamed of, or confused about our own sexuality.
• We cannot admit we might have or are having intercourse, because we feel (or someone told us) it is wrong.
• We are unrealistically romantic about sex: Sex has to be passionate and spontaneous, and birth control seems too premeditated, clinical, and messy.
• We hesitate to ``inconvenience'' our partner. This fear of displeasing him is a measure of the inequality and our lack of control in our relationship.
• We feel, ``It can't happen to me. I won't get pregnant.''
• We 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.
• We don't recognize our deep dissatisfaction with the method we are using, but we begin to use it haphazardly.
• We 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.

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.

Copyright © 1984, 1992, 1998 by the Boston Women's Health Book Collective. All rights reserved. Published by Touchstone, a division of Simon & Schuster Inc.

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