Contraceptive realities are pregnant with inequalities

Rethinking contraceptive roles in a gender-balanced world is a must

It was a random Tuesday in primary six when the head teacher, Mrs. Joy, had split the entire school in half. Girls headed to the auditorium while boys were escorted to begin P.E. earlier than usual. We sat down, and as snacks were passed around the room, Mrs. Joy began her lecture on sex education.

Her entire talk was filled with metaphors on receiving divine wrath. Sex was a sin, and God didn’t like sinners (you’ll burn for all eternity). Purity culture is heavily imbibed by Nigerians from an early age with conservative parents, guardians and teachers reinforcing it through sermons and school assemblies.

Secondary school was only slightly different. A single 10-minute chapter in social studies class was dedicated to sex education, and the advice was typical — abstain. But for those daring to venture into what was deemed a “sordid act,” precautions were prescribed: ensure the use of condoms, consider an IUD or use the pill.

The entire 10-minute lecture perpetuated the notion of women being the focal point of contraceptive responsibility. The widespread and rapid adoption of the pill, alongside the subsequent prioritization of research on contraceptive methods for women, helped lead this paradigm shift.

But my secondary school wasn’t the origin of this bias. Companies have been profiting off of perpetuating this notion for decades.

In her 2012 paper for AMA Journal of Ethics, Lisa Campo-Engelstein explains the contraceptive industry recognized a lucrative opportunity (and achieved $250 million in earnings just in 1938) and initiated a campaign promoting the use of their contraceptive products for women.

Linking women with the responsibility for contraception and aligning contraception with private companies were effective marketing strategies, laying the groundwork for the pill’s success. Its swift rise in popularity reinforced the perception of women as primary consumers of contraceptives. This association of contraception with women resulted in researchers predominantly concentrating on methods for women.

According to Campo-Engelstein, it wasn’t until the 1970s — 50-something whole years after the commencement of research on modern contraceptives for women — that scientists began exploring new types of contraceptives intended for men.

The majority of contemporary birth control options are designed for people with uteruses, leaving folks with penises with typically two choices — condoms or vasectomies. This glaring disparity between the number of contraceptives designed for women and men presents several issues.

When a male contraceptive pill eventually hits the market, it’s expected to be safer than the current pill for people with uteruses. However, I detest the idea that we seem more accepting of women enduring these side effects until men have safer options. While certain side effects may have been deemed acceptable in the past when weighed against the risk of pregnancy, it’s been over 70 years since the introduction of the pill — what justification is there for not having developed a safer alternative by now?

There’s also this assumption that everyone who uses the pill is in a heteronormative relationship or at risk of pregnancy, overlooking those who rely on it for other health reasons like endometriosis or polycystic ovary syndrome.

Contraceptive injustice lacks any sort of logical coherence, fitting seamlessly into patriarchal ideals. The absence of contraceptive choices for men primarily reflects entrenched gender norms that perpetuate the idea of women as the primary caregivers, rather than being solely based on scientific evidence.

The responsibility and side-effects are left to people with uteruses to deal with. From mood swings, anxiety and depression, to skin changes and heavier periods, the many, many risks are now supposedly miniscule unless cis men deal with them. Some women have experienced strokes and blood clots, but this seems, to many, like a comparatively small injustice.

Men’s silence is a huge part of the reason it’s easy to overlook the imbalance.

A paper by Pacific University researchers term this focus on contraceptives for women as “strategic silence.” It allows men to reinforce prevailing notions of hegemonic masculinity that prioritize men’s sexual desires and subtly shift the burden of contraceptive and sexual health responsibility onto women, thereby safeguarding these constructs of masculinity.

As women continue to bear the weight of contraceptive responsibility, facing the numerous side effects and challenges associated with it, the need for change becomes increasingly apparent.

However, true progress can only be achieved through heightened awareness and understanding of contraception, particularly regarding the nuanced realities of contraceptive methods for people with uteruses. Without this crucial shift in perception and discourse, the existing imbalance will persist, perpetuating more inequalities in reproductive health decision-making.